Dry eye: causes, everyday self-care and when to get help, a review

Gritty, sore or itchy eyes can be a sign of dry eye, which the NHS says many people get. This article explains what dry eye is, why it happens, what you can do at home and when to see a professional, using information from the NHS, the US National Eye Institute and MedlinePlus.

1. Introduction

Tears do more than wet the eye. They keep the surface moist, wash away tiny particles and help us see clearly ^[3]. Dry eye develops when the eyes cannot keep a healthy layer of tears. This can be because the tear glands make too few tears, because tears evaporate too quickly, or because the tears do not lubricate the eye well ^{[2, 3]}.

The NHS describes dry eyes as common and usually not serious, and says there are steps you can take to help ^[1]. The National Eye Institute says nearly 16.4 million Americans have dry eye ^[2]. In severe cases that go untreated, the cornea, which is the clear front window of the eye, can be damaged or infected ^{[2, 3]}.

2. Causes and risk factors

Several things can make dry eye more likely ^{[1, 2, 3]}:

• Age. Being over 50 raises the risk, and hormonal changes can lower tear production. Being female is also a risk factor.
• Wearing contact lenses.
• Long periods looking at screens without breaks.
• Dry air from air conditioning or heating, wind or dusty places.
• Smoking, being around smoke, and alcohol.
• Some medicines, such as certain antidepressants, blood pressure medicines and cold or allergy medicines.
• Eyelid problems such as blepharitis (swollen eyelid edges) or meibomianitis, a condition that changes the normal tear film.
• Conditions such as lupus and Sjogren syndrome, which are autoimmune disorders (the body's defence system attacks its own tissue) that can damage tear glands.
• Previous eye surgery or burns, and low intake of vitamin A or omega-3 fatty acids ^{[2, 3]}.

Do not stop a prescribed medicine on your own. The NHS advises asking your doctor first, even if you think the medicine is the cause ^[1].

3. Signs and symptoms

Common symptoms include ^{[1, 2, 3]}:

• Itchy, sore, scratchy or gritty eyes
• A stinging or burning feeling
• Red eyes
• Sensitivity to light
• Blurred vision
• Watering more than usual. This can seem odd, but the NHS lists it as a sign of dry eyes ^[1].

4. Diagnosis and tests

A doctor can check for dry eye during a comprehensive dilated eye exam. The tests may measure how many tears you make, how fast they dry up, and the structure of the eyelids ^[2]. MedlinePlus lists tests such as a slit lamp exam, which is a microscope with a bright light, staining of the surface of the eye with a dye, and the Schirmer test, which measures how fast tears are made ^[3]. If no cause is found, the NHS says you may be referred to an eye specialist (ophthalmologist) ^[1].

5. Treatment and management

Treatment depends on how severe the problem is and what is causing it. Your doctor decides what is best for you. Options described by official sources include ^{[1, 2, 3]}:

• Artificial tears, gels or ointments bought without a prescription. A pharmacist can advise on suitable products ^[1]. MedlinePlus says artificial tears are usually the first step, and that drops without preservatives may suit people whose eyes are sensitive to preservatives ^[3].
• Prescription eye drops for more serious cases, chosen by an eye doctor ^{[2, 3]}.
• Small plugs placed in the tear ducts so that tears stay on the eye for longer ^{[2, 3]}.
• Surgery in uncommon cases where the position of the eyelids is the cause ^{[2, 3]}.
• Treating any health condition that is behind the dryness, which may improve symptoms ^[2].

6. Prevention and self-care

These habits are the main steps suggested by the NHS, the National Eye Institute and MedlinePlus ^{[1, 2, 3]}:

• Clean your eyelids daily. Hold a warm, not hot, damp cloth on the lids, gently massage them, then wipe away crusts with warm cotton wool.
• Take regular breaks from screens, blink more often, and place your screen just below eye level.
• Use a humidifier when the air is dry.
• Avoid smoke, wind and air conditioning, and wear wraparound sunglasses outdoors.
• Rest your eyes from contact lenses by wearing glasses for a while.
• Limit alcohol and do not smoke. Stay hydrated and get enough sleep.

7. When to see a doctor

A pharmacist can advise on self-care and suggest products ^[1]. See an optician or doctor if dry eyes continue after a few weeks of home care, or if you notice any change in the shape of your eyelids ^[1]. Get an urgent appointment for a painful red eye, or a red eye while wearing contact lenses, which can mean an infection ^[1]. Also seek care for discharge, a sore on the eye or eyelid, an eye injury, or dry mouth and dry eyes with joint pain or swelling ^[3].

Some signs need emergency care: changes in vision such as wavy lines, flashing lights or loss of sight, pain when looking at light, a very dark red eye, a red eye with severe headache and nausea, an eye injury, or something stuck in the eye. Do not drive yourself ^[1].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

8. Conclusion

Dry eye is common and often manageable with self-care, artificial tears and attention to triggers such as screens, dry air and smoke. Talk to a professional if it does not settle, and seek urgent help for pain, redness with vision changes or injury. Your doctor decides the right treatment for you.